Popa-Ion Denisa-Ancuța, Boldeanu Lidia, Gheonea Dan-Ionuț, Denicu Madalina Maria, Boldeanu Mihail Virgil, Chiuțu Luminița Cristina
Department of Anesthesiology and Intensive Care, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania.
Department of Microbiology, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania.
Clin Pract. 2024 Jun 18;14(3):1171-1184. doi: 10.3390/clinpract14030093.
The aim of this study was to explore the impact of anesthetic drugs currently used to perform lower digestive endoscopy on serum concentrations of inflammation markers and catecholamines. We selected 120 patients and divided them into three lots of 40 patients each: L1, in which no anesthetics were used; L2, in which propofol was used; and L3, in which propofol combined with fentanyl was used. All patients had serum concentrations of adrenaline/epinephrine (EPI), noradrenaline/norepinephrine (NE), tumor necrosis factor alpha (TNF-α), interleukin-4 (IL-4), IL-6, IL-8, and IL-10, taken at three time points: at the beginning of the endoscopic procedure (T), 15 min after (T), and 2 h after the end of the endoscopic procedure (T). The results of the research showed changes in the levels of catecholamines and interleukins (ILs) at T, with an increased response in L1 above the mean recorded in L2 and L3 ( < 0.001). At T, increased values were recorded in all lots; values were significantly higher in L1. At T, the values recorded in L3 were significantly lower than the values in L2 (student T, < 0.001) and L1, in which the level of these markers continued to increase, reaching double values compared to T (student T, < 0.001). In L2 at T, the dose of propofol correlated much better with NE, EPI, and well-known cytokines. Our results show that propofol combined with fentanyl can significantly inhibit the activation of systemic immune and neuroendocrine response during painless lower digestive endoscopy.
本研究的目的是探讨目前用于进行下消化道内镜检查的麻醉药物对炎症标志物和儿茶酚胺血清浓度的影响。我们选取了120例患者，将他们分为三组，每组40例：L1组，未使用麻醉剂；L2组，使用丙泊酚；L3组，使用丙泊酚联合芬太尼。所有患者在三个时间点采集血清肾上腺素/去甲肾上腺素（EPI）、去甲肾上腺素/去甲肾上腺素（NE）、肿瘤坏死因子α（TNF-α）、白细胞介素-4（IL-4）、IL-6、IL-8和IL-10的浓度：内镜检查开始时（T）、检查后15分钟（T）、内镜检查结束后2小时（T）。研究结果显示，在T时儿茶酚胺和白细胞介素（ILs）水平发生变化，L1组的反应增加，高于L2组和L3组记录的平均值（<0.001）。在T时，所有组的值均升高；L1组的值显著更高。在T时，L3组记录的值显著低于L2组（学生t检验，<0.001）和L1组，L1组这些标志物的水平持续升高，与T时相比达到两倍的值（学生t检验，<0.001）。在L2组的T时，丙泊酚剂量与NE、EPI和知名细胞因子的相关性更好。我们的结果表明，丙泊酚联合芬太尼可在无痛下消化道内镜检查期间显著抑制全身免疫和神经内分泌反应的激活。
